Healthcare Provider Details

I. General information

NPI: 1376293159
Provider Name (Legal Business Name): KRISTINA SOUSOU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MANNING BLVD
ALBANY NY
12208-1789
US

IV. Provider business mailing address

315 S MANNING BLVD
ALBANY NY
12208-1707
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-1550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number343272
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: